Mesothelioma Surgery: Options & Recovery

Mesothelioma is a rare and aggressive cancer that primarily affects the lining of the lungs (pleural mesothelioma), abdomen (peritoneal mesothelioma), or heart (pericardial mesothelioma). Due to its aggressive nature and often late-stage diagnosis, treatment options are often complex and multifaceted. Surgery, while not always an option, can play a crucial role in managing the disease, improving a patient’s prognosis, and enhancing their quality of life. Understanding the different surgical approaches, the potential benefits, and the recovery process is vital for patients and their families navigating this challenging diagnosis.

This article aims to provide a comprehensive overview of mesothelioma surgery, outlining the various surgical options available, the factors that determine surgical candidacy, and what patients can expect during the recovery period. We will delve into the specifics of each surgical procedure, discussing their goals, risks, and potential outcomes. The decision to undergo surgery is a significant one, requiring careful consideration and a thorough discussion with a multidisciplinary team of specialists, including surgeons, oncologists, and radiation oncologists.

Ultimately, the information presented here is intended to empower patients and their loved ones to make informed decisions about their mesothelioma treatment plan. While surgery is not a cure for mesothelioma, it can be a powerful tool in managing the disease, alleviating symptoms, and potentially extending survival. By understanding the nuances of mesothelioma surgery, patients can actively participate in their care and work collaboratively with their medical team to achieve the best possible outcome.

Types of Mesothelioma Surgery

The type of surgery recommended for mesothelioma depends on several factors, including the location and stage of the cancer, the patient’s overall health, and the surgeon’s expertise. There are two primary surgical approaches for pleural mesothelioma, which is the most common type:

Extrapleural Pneumonectomy (EPP)

EPP is a radical surgery that involves removing the entire affected lung, along with the pleura (lining of the lung), part of the diaphragm, part of the pericardium (sac around the heart), and nearby lymph nodes. This is a highly invasive procedure typically reserved for patients with early-stage, localized pleural mesothelioma who are in good overall health. The goal of EPP is to remove as much of the cancer as possible, providing the best chance for long-term survival. However, it’s a demanding surgery with significant risks and a lengthy recovery period.

• Ideal Candidates: Patients with early-stage disease, good lung function in the remaining lung, and excellent overall health.
• Risks: Pneumonia, blood clots, heart problems, prolonged air leak, empyema (pus in the pleural space), and respiratory failure.
• Outcomes: Potentially improved survival rates compared to other treatments in carefully selected patients.

Pleurectomy/Decortication (P/D)

P/D is a less radical surgery than EPP and involves removing the pleura (lining of the lung) and any visible tumor on the surface of the lung, but the lung itself is spared. The “decortication” part of the procedure refers to removing a thick, fibrous peel that can form around the lung due to the mesothelioma. P/D is often preferred for patients who are not strong candidates for EPP due to age, underlying health conditions, or advanced disease. The goal of P/D is to alleviate symptoms, improve lung function, and potentially extend survival, though typically not to the same degree as EPP.

• Ideal Candidates: Patients with more advanced disease, compromised lung function, or other health issues that make EPP too risky.
• Risks: Pneumonia, blood clots, prolonged air leak, bleeding, and recurrence of the tumor.
• Outcomes: Symptom relief, improved lung function, and potentially extended survival, but generally less effective than EPP for long-term control of the disease.

Surgery for Peritoneal Mesothelioma

For peritoneal mesothelioma, the primary surgical approach is:

Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

CRS involves surgically removing all visible tumors from the abdominal cavity. This can be a complex and lengthy procedure, often requiring the removal of parts of the omentum, peritoneum, spleen, and other organs. After CRS, HIPEC is performed, which involves circulating heated chemotherapy drugs directly into the abdominal cavity to kill any remaining cancer cells. This combination of CRS and HIPEC has shown promising results in improving survival rates for patients with peritoneal mesothelioma. For more information, you can refer to Mesothelioma as an additional resource.

• Ideal Candidates: Patients with peritoneal mesothelioma who are in good overall health and whose cancer is limited to the abdominal cavity.
• Risks: Infection, bleeding, bowel obstruction, pancreatic leak, and side effects from chemotherapy.
• Outcomes: Improved survival rates and quality of life compared to chemotherapy alone.

Determining Surgical Candidacy

Not all patients with mesothelioma are suitable candidates for surgery. A thorough evaluation is necessary to determine if surgery is a safe and appropriate treatment option. Factors that influence surgical candidacy include:

Stage of the Cancer

Early-stage mesothelioma is more likely to be amenable to surgical resection than advanced-stage disease. Surgery is generally considered most beneficial when the cancer is localized and has not spread extensively to other parts of the body. For pleural mesothelioma, EPP is typically reserved for early-stage disease. For peritoneal mesothelioma, the ability to remove all visible tumor during CRS is a crucial factor.

Overall Health

Patients need to be in good overall health to tolerate the rigors of major surgery. Pre-existing conditions such as heart disease, lung disease, kidney disease, or diabetes can increase the risk of complications. A thorough medical evaluation, including pulmonary function tests, cardiac testing, and blood work, is necessary to assess a patient’s fitness for surgery.

Lung Function

For pleural mesothelioma, lung function is a critical consideration. EPP involves removing an entire lung, so patients must have adequate lung function in the remaining lung to be able to breathe effectively after surgery. Pulmonary function tests are used to measure lung capacity and airflow.

Extent of Disease

The extent of the cancer’s spread is another important factor. If the cancer has spread extensively to distant organs, surgery may not be beneficial. Imaging studies, such as CT scans, PET scans, and MRI scans, are used to assess the extent of the disease.

Patient Preference

Ultimately, the decision to undergo surgery is a personal one. Patients should be fully informed about the potential benefits and risks of surgery and should have the opportunity to discuss their concerns with their medical team. Patient preferences and values should be taken into account when making treatment decisions.

The Surgical Procedure: What to Expect

The surgical procedure for mesothelioma can be complex and lengthy, depending on the type of surgery being performed. Here’s a general overview of what patients can expect:

Pre-operative Preparation

Before surgery, patients will undergo a thorough medical evaluation to assess their overall health and fitness for surgery. This may include blood tests, imaging studies, pulmonary function tests, and cardiac testing. Patients will also meet with the surgeon and anesthesiologist to discuss the procedure and potential risks. They will receive instructions on what to do before surgery, such as stopping certain medications and fasting.

During the Surgery

The surgery is performed under general anesthesia. The specific steps of the surgery will vary depending on the type of surgery being performed (EPP, P/D, or CRS/HIPEC). The surgeon will make incisions to access the affected area and remove the tumor and any affected tissues. In some cases, reconstruction of the diaphragm or pericardium may be necessary. For CRS/HIPEC, heated chemotherapy drugs will be circulated through the abdominal cavity after the tumor has been removed.

Post-operative Care

After surgery, patients will be closely monitored in the intensive care unit (ICU). They will receive pain medication, oxygen therapy, and other supportive care. Chest tubes may be placed to drain fluid and air from the chest cavity. Patients will gradually be weaned off the ventilator and encouraged to start moving around as soon as possible. The length of the hospital stay will vary depending on the type of surgery and the patient’s overall recovery.

Mesothelioma Surgery Recovery

Recovery from mesothelioma surgery can be a long and challenging process. Patients will need to work closely with their medical team to manage pain, prevent complications, and regain their strength and function.

Pain Management

Pain is a common side effect of mesothelioma surgery. Patients will receive pain medication to help manage their pain. It’s important to communicate with the medical team about pain levels so that the medication can be adjusted as needed.

Pulmonary Rehabilitation

Pulmonary rehabilitation is an important part of the recovery process, especially for patients who have undergone EPP or P/D. Pulmonary rehabilitation involves exercises and techniques to improve lung function, breathing, and exercise tolerance. A respiratory therapist can help patients learn how to breathe more efficiently and manage shortness of breath.

Physical Therapy

Physical therapy can help patients regain their strength, mobility, and function after surgery. A physical therapist can develop an individualized exercise program to help patients improve their range of motion, balance, and endurance.

Nutritional Support

Good nutrition is essential for healing and recovery after surgery. Patients may need to eat a high-protein, high-calorie diet to help rebuild muscle and tissues. A registered dietitian can provide guidance on how to meet nutritional needs during the recovery process.

Emotional Support

Dealing with mesothelioma can be emotionally challenging. Patients may experience anxiety, depression, and fear. It’s important to seek emotional support from family, friends, support groups, or a mental health professional. Counseling and support groups can provide a safe space for patients to share their experiences and connect with others who understand what they are going through.

Potential Risks and Complications

Like any major surgery, mesothelioma surgery carries potential risks and complications. These risks can vary depending on the type of surgery, the patient’s overall health, and the surgeon’s experience. Some potential risks and complications include:

• Infection
• Bleeding
• Blood clots
• Pneumonia
• Prolonged air leak
• Heart problems
• Kidney failure
• Respiratory failure
• Bowel obstruction (for peritoneal mesothelioma surgery)
• Pancreatic leak (for peritoneal mesothelioma surgery)
• Side effects from chemotherapy (for CRS/HIPEC)
• Recurrence of the tumor

Conclusion

Mesothelioma surgery can be a valuable treatment option for carefully selected patients. The type of surgery recommended depends on the location and stage of the cancer, the patient’s overall health, and the surgeon’s expertise. While surgery is not a cure for mesothelioma, it can help to alleviate symptoms, improve lung function, and potentially extend survival. It is crucial for patients to discuss their treatment options with a multidisciplinary team of specialists and to make informed decisions based on their individual circumstances. The recovery process can be long and challenging, but with proper medical care, rehabilitation, and emotional support, patients can improve their quality of life and maximize their chances of a positive outcome.

Conclusion

In conclusion, surgery for mesothelioma, while not a cure, remains a crucial component in managing this aggressive cancer and improving patient outcomes. As we have explored, different surgical approaches, including extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D), offer varying degrees of tumor removal and potential benefits, each with its own set of risks and considerations. The decision regarding which surgical strategy is best suited for an individual patient requires a careful and comprehensive evaluation by a multidisciplinary team of specialists, taking into account factors such as disease stage, overall health, and individual preferences. Furthermore, advancements in surgical techniques and perioperative care continue to refine the role of surgery in mesothelioma treatment, aiming to minimize complications and maximize the potential for long-term survival.

The information presented here underscores the importance of seeking expert medical advice from experienced mesothelioma specialists. If you or a loved one has been diagnosed with mesothelioma, understanding your treatment options, including the potential benefits and risks of surgery, is paramount. We encourage you to consult with a qualified physician to discuss your individual situation and develop a personalized treatment plan. Remember, early detection and access to specialized care are vital in the fight against mesothelioma. For further information and resources, please visit the Mesothelioma Applied Research Foundation website at https://www.curemeso.org/.